•	RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02050
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “pain right ankle” with a disability rating of 10%.    

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 20070927	VARD - 20080408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain Right Ankle	5099-5003	10%	Right Ankle, Status Post (S/P) Multiple Surgeries	5299-5271	10%	20080227	
Right Knee Pain	Not Unfitting	Right Knee Bone/Cartilage Donor Site with Evidence of Mild Degenerative Changes	5010	10%	20080228	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle pain began in March 2005 when he was running along the road and felt a “snap.”  He subsequently underwent three right ankle surgeries, with the first in November 2005 (right ankle osteochondral defect, excision, curettage and microfracture); the second in April 2006 (right ankle osteochondral allograft transplant from the trochlear ridge of the right knee); and the third in March 2007 (hardware removal and debridement of portions of the anterior, anterolateral, medial gutters).  

At an orthopedic follow-up on 2 April 2007, incisions were well-healed, and right ankle range of motion (ROM) showed dorsiflexion to 10 degrees (normal 20) and planter flexion to 35 degrees (normal 45).  There was no tenderness over the anterior lateral gutter, and motor strength was 4+/5 in the peroneal tendons.  The CI continued postoperative physical therapy, and at an appointment on 22 May 2007, he stated that he was pleased with his improvement and overall status; dorsiflexion was to 15 degrees and plantar flexion to 40 degrees.  At an orthopedic visit on 23 May 2007, the CI’s pain was much improved from prior to his arthroscopic debridement, and the he could perform most of his activities without difficulty.  The examiner noted “good active and passive ROM.”  On 30 August 2007, X-rays revealed intact bony structures and interval removal of the orthopedic side plate from the distal fibula.  

The 6 September 2007 MEB NARSUM examination, 4 months before separation, noted CI complaints of constant daily shooting pain, rated at 4/10, that became 6/10 throbbing pain with any physical activity.  The examiner noted that the CI walked with a limp and was wearing an ankle brace.  Right ankle ROM, following repetition, revealed dorsiflexion to 35 degrees and plantar flexion to 20 degrees with pain at extremes and after testing. 

At the 27 February 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pain with stiffness which limited walking, and “intermittent, but frequent” use of a brace and cane.   Physical examination showed an antalgic gait and no effusion.  Following repetition, dorsiflexion was to 10 degrees, with pain, and plantar flexion to 45 degrees, without pain; ROM was not additionally limited by repetitive movement.   At a VA orthopedic examination on 8 May 2008, the provider assessed the CI’s ankle instability and recommended further surgical interventions to include lateral ligament reconstruction, peroneal tendon debridement, removal of remaining hardware, or ultimately an ankle fusion or replacement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency pain policy and slight/constant pain.  The VA also rated the right ankle condition 10%, analogously coded 5299-5271 (ankle, limited motion of) based on the C&P examination, citing limitation of motion with pain at the endpoint.  Upon deliberation, members agreed the CI’s overall ankle limitation of motion was more appropriately characterized as “moderate” thereby supporting a 10% rating.  A higher rating of 20% was not indicated in the absence of “marked” limited ankle ROM.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable or not advantageous to rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right ankle condition

Contended PEB Condition:  Right Knee Pain S/P Allograft Donor Site.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or judged to fail retention standards.  As mentioned above, the CI had a right ankle osteochondral allograft transplant in April 2006, which used small plugs of healthy cartilage removed from the right knee.  After the procedure, he complained of constant daily knee pain in the area of the graft donor site.  

On the DD Form 2807-1, the CI reported pain in the area of bone graft (lateral distal femur) and that he wore a knee brace.  The examiner further noted that daily pain was constant and rated at 4/10, and increased to 6/10 with physical activity.  The surgical scar was well-healed, but the CI experienced shooting pain from scar around the front of the knee.  

At the MEB NARSUM examination, ROM studies showed extension to 0 degrees (normal) and flexion to 120 degrees (normal 140) after repetition.  The CI was able to deep knee bend to 45 degrees with ankle pain preventing further flexion of the knee.  He subsequently underwent a medical retention board for reclassification, but was unable to satisfactorily complete military specialty requirements (not due to either the ankle or knee condition).  On 8 February 2008, the CI reported pain and popping after the donor surgery and noted giving way, but no effusion or locking.  The C&P examination, 2 months after separation, showed ROM from 0-140 degrees with pain at the end of flexion.  A right knee examination on 28 July 2008, 7 months after separation, was essentially within normal limits, although the CI reported knee pain. He received a steroid/anesthetic injection, and later had a Supartz (sodium hyaluronate) injection on 26 September 2008.

The panel considered whether the knee condition was separately unfitting, and agreed that although the CI had knee pain at the time of separation, there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right ankle pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right knee condition, the panel recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR, XXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR)
reviewed your application and found your separation disability rating and your
separation from the Army for disability with severance pay to be accurate. I have
reviewed the Board’s recommendation and record of proceedings (copy enclosed), and
I accept its recommendation. I regret to inform you that your application to the DoD
PDBR is denied.

This decision is final. Recourse within the Department of Defense or the
Department of the Army is exhausted; however, you have the option to seek relief by
filing suit in a court of appropriate jurisdiction.

Sincerely,

9/13/2018
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